Compliance Auditor, Intermediate (CEMC, CPC, or CPMA)
Join UPMC Corporate Compliance as an Intermediate Compliance Auditor! Are you passionate about ensuring accuracy and compliance in healthcare documentation and billing? Do you thrive in a dynamic environment where your expertise can make a significant impact? UPMC Corporate Compliance is seeking a dedicated and detail-oriented Intermediate Compliance Auditor to join our team! This position will be based out of Forbes Tower in Pittsburgh, PA. This is an onsite position with the potential to work from home. Key Responsibilities: Comprehensive Auditing:Conduct UPMC-wide audits to ensure medical record documentation supports the services coded and billed in accordance with state and federal regulations. Code Validation:Validate ICD-10-CM, CPT, and HCPCS codes to ensure consistency and efficiency in claims processing, data collection, and quality reporting. Regulatory Compliance:Conduct audits on various compliance topics to evaluate adherence to state and federal laws, regulations, and policies. Reporting:Prepare written reports of audit results, including recommendations for improvement and compliance with state and federal laws and regulations. Stakeholder Communication:Communicate audit findings and corrective actions to key stakeholders. Leadership Advising:Advise leadership on regulatory requirements for coding documentation and billing to ensure services are submitted according to payor guidelines and related regulations. Knowledge Maintenance:Stay current with regulatory trends and changes in coding policy and reimbursement methods. Why UPMC? At UPMC, we are committed to fostering a culture of compliance and excellence. As an Intermediate Compliance Auditor, you will play a crucial role in upholding our standards and ensuring the highest level of integrity in our operations. Join us and be part of a team that values your expertise and dedication to making a difference in healthcare compliance. Apply today and take the next step in your career with UPMC Corporate Compliance!
- High School Diploma or equivalent required.
- Associate's degree or comparable technical school diploma is preferred.
- 3 or more years of experience in medical coding, billing, auditing and compliance.
- Extensive knowledge of CMS, and third-party payer coding, billing, and documentation compliance regulations required (MS-DRG, APR-DRG, APC, APG or ICD10-CM, HCPCS, CPT, Modifiers, etc.).
- Knowledge of coding/classification systems appropriate for inpatient /outpatient, DRG prospective payment system or office setting E/M codes.
- Experience in an academic medical center setting is strongly preferred.
- Proficiency with associated technology solutions such as Microsoft Excel, Word and PowerPoint is strongly preferred.
- Must be able to demonstrate a high degree of professionalism, enthusiasm and initiative daily.
- Must have strong interpersonal, organizational, analytical and communication skills.
- Ability to work in a fast-paced environment.
- Must have ability to manage multiple tasks and projects and forge strong interpersonal relationships within the department and with other departments.
- Ability to identify, interpret and summarize relevant policy and regulation in a clear and timely manner is essential.
- Experience researching and interpreting regulation and performing internal investigations is essential.
Licensure, Certifications, and Clearances: One of the following is required:
- Certified Coding Specialist (CCS)
- Certified Inpatient Coder (CIC)
- Certified Evaluation & Management Coder (CEMC)
- Certified Professional Medical Auditor (CPMA)
- Certified Professional Coder (CPC)
- Certified Medical Coder (CMC)
- OR Registered Health Information Administrator (RHIA)
- Registered Health Information Technician (RHIT)
- OR Licensed Professional Nurse (LPN)
- Registered Nurse (RN)
Required:
- Act 34
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